[A case of primary hepatic carcinoid. A report of its surgical resolution]. / Su di un caso di carcinoide epatico primitivo. Descrizione della sua risoluzione chirurgica.

Primary hepatic carcinoid tumors are extremely rare; conversely, the liver is the most frequent site of metastases from gastrointestinal carcinoids. Clinically, primary lesions are characterized, in most cases, by the absence of an overt endocrine syndrome. Histologic findings and immunohistochemical demonstrations of chromogranin and neuron specific enolase, generally, enable the neuroendocrine origin of these neoplasms to be established. Prognosis after surgical treatment of primary hepatic carcinoids seems to be more favorable when compared with other hepatic carcinomas.

Function of the anal sphincters following anterior resections of rectum.

The purpose of the present work is to evaluate the function of the anal sphincter following anterior resections of the rectum. Our data have shown that the anorectal reflex did not depend on the presence of the rectal mucosa. The external anal sphincter contraction involves a reflex which is initiated by stretch receptors in the levator ani muscle. The internal anal sphincter relaxation is likely a local reflex involving nerve pathways not yet completely defined.

Rectoanal reflex in healthy subject.

The present work was performed in order to examine the rectoanal reflex in healthy subject. Our findings suggest that the fecal continence is sustained by both the anal sphincters. The maximal anal pressure at rest is governed by activity of the internal sphincter while the external anal sphincter promptly contracts when the rectum is distended.

Function of the anal sphincters following pull-through operations without anal eversion.

It has been investigated the function of the anal sphincters following Bacon type pull-through operation. Our data have shown a significant decrease of the anal resting pressure after pull-through excision signifying an impairment in the internal sphincter function. But the tonic external sphincter contraction induced by stimulation can maintain continence.

Anorectal physiology after anterior resection and pull-through operation.

Sensory and motor investigations have been performed in normal subjects, in patients who had undergone low anterior resection of the rectum and in patients following Bacon-type pull-through operation. The electromechanical relationship has been clearly defined in the anal sphincter activity. The motor findings, the threshold for sensation and its quality in the patients following low anterior resection were similar to those of the controls. Following pull-through operation the anorectal inhibitory reflex is frequently replaced by a contraction of the sphincteric zone. But, sometimes, this reflex is preserved as well as a fine discriminatory sensation. These data suggest that at least some of the mechanisms of anal sphincter continence have been preserved even after complete excision of the rectum.

Content of quinolinic acid and of other tryptophan metabolites increases in brain regions of rats used as experimental models of hepatic encephalopathy.

The content of the tryptophan metabolites quinolinic acid (QUIN), 5-hydroxytryptamine (5-HT), and 5-hydroxyindoleacetic acid (5-HIAA) was measured in various brain areas of rats bearing a portocaval anastomosis (PCA) for 4 weeks, using mass fragmentography or HPLC. In these animals, the content of the excitotoxic compound QUIN increased by 75% in the cortex and 125% in the cerebellum. The content of 5-HT increased by 27% in the brainstem. No changes occurred in other brain areas. On the other hand, the content of 5-HIAA increased by 66% in the cortex, 65% in the caudate, 64% in the hippocampus, 120% in the diencephalon, and 185% in the brainstem. Probenecid administration caused a larger increase of 5-HIAA accumulation in various brain areas of PCA-bearing rats than in those of sham-operated controls. The cortical content of QUIN and 5-HIAA increased after administration of ammonium acetate (7 mmol/kg), whereas an equimolar amount of sodium acetate was inactive. These results confirm that profound changes in the disposition of tryptophan occur in the brains of experimental animals used as models of hepatic encephalopathy. Furthermore, this study adds the excitotoxic compound QUIN to the list of molecules possibly involved in the pathogenesis of this brain disorder.

Clinicopathologic characteristics and outcome indicators in node-negative gastric cancer.

BACKGROUND AND OBJECTIVES: The relationship between the number of lymph nodes examined and the outcome in patients with node-negative (N(-)) gastric cancer was studied. We compared N(-) patients to those with nodal involvement (N(+)) to identify clinicopathologic characteristics of N(-) gastric cancer. Finally, we evaluated outcome indicators in this group of patients. METHODS: Of 367 patients, 130 (35.4%) were N(-). These patients were stratified according to the main prognostic variables, to assess differences with N(+) cases. A statistical analysis using the Cox model was performed to estimate outcome indicators. RESULTS: N(-) gastric carcinomas were significantly different from N(+) cases in terms of tumor depth and site, TNM stage, grading, residual disease, and vessel involvement. The overall 5-year survival rate was 72%. It was 82% in those patients with more than 15 nodes retrieved and 59% in the others. Serosal involvement, residual disease, and poor differentiation were independent prognostic factors. CONCLUSIONS: The clinicopathologic factors and outcome of N(-) cases were similar to those of early gastric cancer. At least 15 examined nodes appears to be necessary to define a case as N(-). The prognostic value of D2 lymphadenectomy in N(-) patients suggests a biologic role of micrometastases.

Clinicopathologic findings and results of surgical treatment in cardiac adenocarcinoma.

BACKGROUND AND OBJECTIVES: There is a great deal of controversy regarding the definition, classification, and staging of cardiac adenocarcinoma (CA). Recently, a shift from distal to proximal lesions has been documented in gastric cancer. We have stratified our cases of gastric cancer as CA, distal gastric cancer (DGC), and stump cancer (SC). METHODS: Between 1986 and 1998, 450 patients with gastric cancer were operated on at our institute. The resectability rate was 81.6%. Of 367 patients, 48 were CA, 298 DGC, and 21 SC. These 3 groups were compared in terms of clinicopathologic factors and survival rates. RESULTS: CA was significantly higher in male patients and showed a prevalence of the Lauren intestinal type. Regarding staging parameters, CA showed a higher rate of T3 tumors and of resection line involvement. Five-year survival rates were 23. 2% for CA, 45.0% for DGC, and 17.4% for SC. CONCLUSIONS: A possible cause of the poor outcome of CA is presentation at a more advanced stage. CA was similar to SC as far as epidemiology, pathologic factors, and survival rates.